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Proven lifestyle and therapeutic interventions to reduce risk and slow the progression of chronic kidney disease (CKD) are well-established. There is a compelling need for countries and regions to develop organizational structures that allow for the early identification of people at risk or with CKD who will potentially benefit from these proven interventions. We aimed to report the current status of these programs using global survey data conducted by the International Society of Nephrology (ISN).
We assessed structures for the detection and monitoring of CKD, including CKD surveillance systems in the form of registries, community-based detection programs, opportunistic screening practices, and the availability of measurement tools for risk identification.
Of all participating countries (N=167), 19% (n=31) had CKD registries, and 25% (n=40) had implemented CKD detection programs as part of their national policies, with the highest proportion observed in high-income and upper-middle-income countries (n=23; 37% and n=11; 30%, respectively). There were variations in the availability of CKD detection programs, with 50% (n=20) of countries using a reactive approach (defined as managing cases as they are identified through practice), 43% (n=17) adopting an active approach (defined as conducting screening in at-risk populations) through routine health encounters, and 7% (n=3) relying on specific screening initiatives. Routine screening for CKD in high-risk populations was widespread, particularly for diabetes (n=152; 91%) and hypertension (n=148; 89%). Access to detection tools, such as eGFR and quantitative measurement of albuminuria, were limited at secondary/tertiary, compared to primary healthcare levels, especially in low-income (eGFR: n=7; 39% vs n=4; 22%, UACR: n=8; 44% vs n=5; 28%) to lower-middle-income (eGFR; n=32; 73% vs n=17; 39%, UACR; n=31; 70% vs n=17; 39%) countries, potentially hindering early CKD detection.
This comprehensive survey highlights global heterogeneity in the organization and structures (surveillance systems, detection programs, and tools) for risk identification for CKD. Ongoing efforts should be geared towards bridging such disparities to achieve optimal prevention and reduce the risk of progression in people with CKD.